7a. Urinary System Disorders

Cystitis

affects the ability to urinate - infection or inflammation of the bladder

Causes -

• idiopathic - unknown cause

• trauma - secondary to an injury

• neoplasia

• stress - new people/animal, fireworks..)

Clinical Signs -

• Pollakiuria - small amounts of urine

• haematuria

• incontinence

• Dysuria / Straining

• Urine Scolding

Treatment -

• Assist VS with diagnostics

• medication under VS direction

• monitor vital signs

• close observation

• urinary catheterisation

• assist with bladder lavage

• monitor urine output

• monitor behaviour

Urolithiasis

bladder stones

most common in urinary bladder - may drop into the urethra

Causes -

• UTI

• high dietary intake of certain minerals

• disease of genetic predisposition

Clinical Signs -

• Dysuria

• Hematuria

• Pollakuria

• scalding or perineum

• extended penis

• distended bladder

Diagnostics -

• physical examination

• ultrasonography

• urethral endoscopy

Treatment -

•Surgery or manual retrieval

•Laser or shockwave - pulse will break up stones to make them easier to pass

•Bladder lavage

•Urine culture and analysis of urolith

•Dietary considerations

•Monitor vital signs

•Fresh water availability

•Monitor urine output

•Frequency

•Colour

•Amount

•Monitor behaviour

Feline Lower Urinary Tract Disease

May be obstructive or non-obstructive

Commonly seen in:

•Overweight cats

•Young – middle-aged males

•Indoor multi-cat households where the diet is dry food

•Stressed cats

•Clinical signs

•See cystitis

Treatment – obstructive

•Urgent

•Blood tests

•Cystocentesis

•IV fluid therapy

•GA & blockage removal

•Bladder flush & catheterisation

•Medication

Nursing care – obstructive

•Monitoring

•Blood tests

•IV fluid therapy

•Maintenance of urinary catheter if applicable

•Cleanliness

•Medication

Treatment – non-obstructive

•Long-term management

•Diet

•Weight control

•Encourage increased water intake

•Supplementation of GAG

•Reduce stress levels

•Medical checks

Acute Renal Failure

May occur as a consequence to:

•Decreased blood flow to the kidneys (e.g hypovolaemicshock)

•Direct effect on the cells of the kidneys (e.g. toxins (antifreeze), infectious causes (leptospirosis))

•Post-renal obstruction (e.g. urethral stone)

•Chronic renal failure

Diagnostics

•Blood tests

•Urinalysis

•Radiography

•Ultrasonography

Treatment

•IV fluids

•Drug therapy

•Antiemetics

•Peritoneal dialysis

Nursing care

•Barrier nursing

•Fluid therapy

•Monitoring

•Hydration

•Bodyweight

•Vomiting

•Medication

•Diet

•Grooming and cleanliness

Chronic Renal Failure

•Very gradual onset of clinical signs as loss of renal function gets progressively worse

•Results in azotaemia (uremia)

•Accumulation in the blood of nitrogenous waste products (urea) that are usually excreted in the urine  

Clinical signs -

•Symptoms when >75% of renal function has been lost

Causes include:

•Acute renal failure

•Congenital/hereditary disease (e.g. polycystic kidney disease)

•Glomerulonephritis

•Ischaemic damage

•Hypercalcaemia

•Idiopathic

Diagnostics -

•Biochemistry

•Haematology

•Urinalysis

•Radiography

•Blood pressure monitoring

Treatment -

•Treat underlying cause

•IV therapy & electrolyte supplementation

•Antiemetics

•Dietary management

•Vitamin B supplementation & Erythropoietin by injection

Nursing Care -

•Monitoring

•IV therapy and medication

•Ad lib fresh water and dietary adjustments

•Taking patient out regularly

Nephritis

• inflammation of the kidneys

• severe kidney infection

• high body temperature

• symptoms sometimes unnoticeable

• loose the ability to filter toxins

Clinical Signs -

•Fever

•Pain in kidneys

•Swelling or inflammation of the kidneys

•Blood in urine

•Pus in urine

•Heightened levels of serum protein found in blood

•Higher than normal levels of urea and creatinine in blood

Diagnosis -

•Physical examination

•Ultrasound scan

•Haematology

•Urinalysis

Treatment and nursing care -

•Fresh water availability

•Electrolytes

•Dietary management

•Medication under VS direction

•Observations and vital signs

•Monitor urine output

•Frequency

•Colour

•Amount

•Monitor behaviour

Ruptured Bladder

Possible Causes -

• trauma of the bladder wall

• tear in the urachus

• urinary obstructions

• tear in dorsal part of bladder

Clinical Signs -

Abnormal urination 

Decreased faecal output

Abnormal levels of urine 

Lack of appetite

Increased HR

Discomfort when urinating 

Cardiac arrythmias

Diagnosis -

• Physical examination

• history of symptoms

• haematology

• ultrasound

• cystoscopy

Treatment -

•Stabilisation of the patient

•Surgical repair and drainage of the uroperitoneum

•Medication under VS direction

•Fresh water availability, IVFT

•Observations and vital signs

•Monitor urine output and management of urinary catheter if placed

•Frequency

•Colour

•Amount

•Monitor behaviour